Junctional Nevus and Early Melanoma on Sun-Damaged Skin of the Head/Neck: A Clinico-Pathologic Challenge

Elvira Moscarella; Pascale Guitera; Richard A.  Scolyer; Lilian Rocha; Luc Thomas; Andrea Ronchi; Camila Scharf; Gabriella Brancaccio; Giuseppe Argenziano

doi:10.5826/dpc.1302a122

Junctional Nevus and Early Melanoma on Sun-Damaged Skin of the Head/Neck: A Clinico-Pathologic Challenge

Authors

Elvira Moscarella Dermatology Unit, University of Campania L.Vanvitelli, Naples, Italy
Pascale Guitera Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
Richard A. Scolyer Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
Lilian Rocha Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
Luc Thomas Centre Hospitalier Lyon Sud; Lyon 1 University; Lyons cancer research center UMR INSERM U1052 - CNRS5286 - UCBL1, Lyons France
Andrea Ronchi Pathology Unit, University of Campania L. Vanvitelli, Naples, Italy
Camila Scharf Dermatology Unit, University of Campania L.Vanvitelli, Naples, Italy
Gabriella Brancaccio Dermatology Unit, University of Campania L.Vanvitelli, Naples, Italy
Giuseppe Argenziano Dermatology Unit, University of Campania L.Vanvitelli, Naples, Italy

Keywords:

melanoma, junctional nevus, dermoscopy, partial biopsy, facial lesions

Abstract

Introduction: Melanoma on the head/neck area can show subtle clinical, dermoscopic and histologic features at early stages, being difficult to differentiate from junctional nevi.

Objectives: This case series aims to raise awareness on the topic of misdiagnosis of early lentigo maligna as junctional nevi.

Methods: From the databases of three pigmented lesion clinics in Italy, Australia, and France, we retrieved all cases of lesions of the head/neck area with an initial histopathologic diagnosis of junctional nevus (JN) or dysplastic junctional nevus (DJN) which subsequently recurred and were ultimately diagnosed as melanoma. Moreover, we also retrieved those cases with an initial diagnosis of JN/DJN made on a partial biopsy that were diagnosed as melanoma after complete surgical removal.

Results: Here we report 14 cases in which the initial histologic diagnosis was junctional nevus or dysplastic junctional nevus. The lesions recurred over time with a final diagnosis of lentigo maligna.

Conclusions: Clinicians should critically question a given histologic diagnosis of junctional or dysplastic junctional nevus on the head/neck area if the clinical or dermoscopic features are discordant. Clinico-pathologic correlation is the best way to increase diagnostic accuracy and optimize management for the patient.

References

Reed JA, Shea CR. Lentigo maligna: melanoma in situ on chronically sun-damaged skin. Arch Pathol Lab Med. 2011;135(7):838-841. DOI: 10.5858/2011-0051-RAIR.1. PMID: 21732771.

Ferrara G, Ligrone L, Zalaudek I, Mordente I, Argenziano G. Lentigo maligna in a young adult. Dermatology. 2008; 17(1):66-68. DOI: 10.1159/000125549. PMID: 18401175.

Stolz W, Schiffner R, Burgdorf WH. Dermatoscopy for facial pigmented skin lesions. Clin Dermatol. 2002; 20(3):276-278. DOI: 10.1016/s0738-081x(02)00221-3. PMID: 12074867.

Witt C, Krengel S. Clinical and epidemiological aspects of subtypes of melanocytic nevi (Flat nevi, Miescher nevi, Unna nevi). Dermatol Online J. 2010;16(1):1. PMID: 20137743.

Zalaudek I, Cota C, Ferrara G, et al. Flat pigmented macules on sun-damaged skin of the head/neck: junctional nevus, atypical lentiginous nevus, or melanoma in situ? Clin Dermatol. 2014;32(1):88-93. DOI: 10.1016/j.clindermatol.2013.05.029. PMID: 24314381.

Sina N, Saeed-Kamil Z, Ghazarian D. Pitfalls in the diagnosis of lentigo maligna and lentigo maligna melanoma, facts and an opinion. J Clin Pathol. 2021;74(1):7-9. DOI: 10.1136/jclinpath-2020-207051. PMID: 33051287.

Farrahi F, Egbert BM, Swetter SM. Histologic similarities between lentigo maligna and dysplastic nevus: importance of clinicopathologic distinction. J Cutan Pathol. 2005;32(6):405-412. DOI: 10.1111/j.0303-6987.2005.00355.x. PMID: 15953373.

Lallas A, Lallas K, Tschandl P, et al. The dermoscopic inverse approach significantly improves the accuracy of human readers for lentigo maligna diagnosis. J Am Acad Dermatol. 2021;84(2):381-389. DOI: 10.1016/j.jaad.2020.06.085. PMID: 32592885.

McCarthy SW, Scolyer RA. Melanocytic lesions of the face: diagnostic pitfalls. Ann Acad Med Singap. 2004;33(4 Suppl):3-14. PMID: 15389301

Moscarella E, Kyrgidis A, Sperduti I, et al. Age-related prevalence and morphological appearance of facial skin tumours: a prospective, cross-sectional, observational, multicentre study with special emphasis on melanocytic tumours. J Eur Acad Dermatol Venereol. 2015;29(7):1331-1338. DOI: 10.1111/jdv.12844. PMID: 25399612.

Kossard S. Atypical lentiginous junctional naevi of the elderly and melanoma. Australas J Dermatol. 2002;43(2):93-101. DOI: 10.1046/j.1440-0960.2002.t01-1-00568.x. PMID: 11982564.

Kossard S, Commens C, Symons M, Doyle J. Lentinginous dysplastic naevi in the elderly: a potential precursor for malignant melanoma. Australas J Dermatol. 1991;32(1):27-37. DOI: 10.1111/j.1440-0960.1991.tb00679.x. PMID: 1930003.

Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472-492. DOI: 10.3322/caac.21409. PMID: 29028110. PMCID: PMC5978683.

Ding Y, Jiang R, Chen Y, et al. Comparing the characteristics and predicting the survival of patients with head and neck melanoma versus body melanoma: a population-based study. BMC Cancer. 2021;21(1):420. DOI: 10.1186/s12885-021-08105-y. PMID: 33863315. PMCID: PMC8052690.

Grossman D, Okwundu N, Bartlett EK, et al. Prognostic Gene Expression Profiling in Cutaneous Melanoma: Identifying the Knowledge Gaps and Assessing the Clinical Benefit. JAMA Dermatol. 2020;156(9):1004-1011. DOI: 10.1001/jamadermatol.2020.1729. PMID: 32725204. PMCID: PMC8275355.